title: Endovascular abdominal aneurysm repair and impact of systematic preoperative embolization of collateral arteries: endoleak analysis and long-term follow-up.
abstract: OBJECTIVE
  To report our results of endovascular aneurysm repair (EVAR) over a 10-year period using systematic preoperative collateral artery embolization.
  
  
  METHODS
  From 1999 until 2009, 124 patients (117 men; mean age 70.8 years) with abdominal aortic aneurysm (AAA) underwent embolization of patent lumbar and/or inferior mesenteric arteries prior to elective EVAR procedures. Embolization was systematically attempted and, whenever possible, performed using microcoils and a coaxial technique. Follow-up included computed tomography and/or magnetic resonance imaging and abdominal radiography.
  
  
  RESULTS
  The technical success for EVAR was 96% (119/124), with 4 patients dying within 30 days (3.2% perioperative mortality) and 1 type III endoleak accounting for the failures. Collateral arteries were occluded spontaneously or by embolization in 60 (48%) of 124 patients. The endoleak rate was 50.9% (74 in 61 patients), most of which were type II (19%). Over a mean clinical follow-up of 60.5±34.1 months (range 1-144), aneurysm sac dimensions decreased in 66 patients, increased in 19 patients, and were stable in 35. The endoleak rate was significantly higher in the patients with increasing sac diameter (p<0.001). Among the patients with patent collateral arteries, 38/64 (59.3%) developed 46 leaks, while 28 leaks appeared in 23 (41%) of 56 patients with collateral artery occlusion (p=0.069). The type II endoleak rate significantly differed between these two groups (47.8% vs. 3.6%, p<0.001).
  
  
  CONCLUSIONS
  Preoperative collateral embolization seems to be a valid method of reducing the incidence of type II endoleak, improving the long-term outcome.
authors.affiliation: 1 Department of Radiology, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Alerci
authors.forename: Alessia
authors.initials: A
authors.lastname: Giamboni
authors.forename: Rolf
authors.initials: R
authors.lastname: Wyttenbach
authors.forename: Alessandra Pia
authors.initials: AP
authors.lastname: Porretta
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonucci
authors.forename: Marcel
authors.initials: M
authors.lastname: Bogen
authors.forename: Marco
authors.initials: M
authors.lastname: Toderi
authors.forename: Adriano
authors.initials: A
authors.lastname: Guerra
authors.forename: Fabio
authors.initials: F
authors.lastname: Sartori
authors.forename: Paolo
authors.initials: P
authors.lastname: Tutta
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
authors.forename: Costanzo
authors.initials: C
authors.lastname: Limoni
authors.forename: Augusto
authors.initials: A
authors.lastname: Gallino
authors.forename: Ludwig K
authors.initials: LK
authors.lastname: Von Segesser
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D003097:Collateral Circulation; D017558:Elective Surgical Procedures; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D057867:Endoleak / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000503:physiopathology*; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome